Last year my penis began to point downward and developed an indentation on the topside. My penis is now bent about 90 degrees and it is hinged. I can straighten it enough to pull it where it needs to go…no pain, ever. After seeing a urologist that prescribed Potaba, then researching about the various treatments, I found several additional options that may help, including colchicine, collagenase, and finally surgery. What is the best treatment or surgical option for this kind of PD?

It seems that you have a rather severe degree of Peyronie’s disease with a 90-degree downward or ventral bend. The fact that you have a hinge-effect suggests that there may also be some indentation which is destabilizing the penile shaft resulting in the ability to flex the penis. If you are sexually functional at this time and it is not causing you or your partner any difficulty, then no treatment is necessary. On the other hand, because the curvature is downward or ventral it is very difficult to get any injectable drug into the plaque to result in benefit. My experience with verapamil injections in patients with advanced ventral curvature has resulted in very little benefit. In addition, surgery may be an option, but in men with advanced ventral curvatures who undergo incision and grafting, there is a significant risk of post-operative erectile dysfunction. Colchicine has not been shown to be very beneficial, nor has any other oral treatment for such severe Peyronie’s disease. I therefore would not recommend oral therapy as a likely benefit for you. Colchicine is not yet available and it is still some time before phase two clinical trials will begin. It is possible that patients with ventral curves will be excluded from the initial trials because of the overall poor response rate with downward curvatures. Therefore, I think surgery is going to be your best option should you want to correct the deformity. You will certainly need more advanced evaluation to determine the quality of your penile blood flow and the actual location of the plaque to determine whether the plication operation would make sense for you or whether a penile prosthesis would be indicated. I would caution you if a grafting procedure is recommended, that the risk of post-operative erectile dysfunction is around 50% even in those men who have good pre-operative rigidity.